There was an NHS recruitment and retention crisis long before the pandemic. Whilst politicians of most shades repeated mantra like lines relating to more “nurses”, the crisis was increasingly evident amongst allied health professions and, as the Richards’ Report in November 2020 confirmed, at its gravest in imaging.
This crisis was at the root of why the NHS pay Review Body recommended an increase for staff in England and Wales that was 3 times the Government’s recommendation. The argument that there is a crisis has been won. Now the discussion needs to move on to what needs to happen to address the crisis.
There will inevitably be 2 complementary strands to tackling the crisis. The first is securing commitment to adequate levels of investment in the NHS. Again the argument to prioritise the NHS has already been won. At the 2019 General Election the NHS was every politicians favourite child with competing promises about who loved it most. However, there wasn’t and isn’t a national consensus about how much extra investment is needed.
Finding the money
Since 1997, when the Blair Government committed to matching Germany and France’s share of around 9% of GDP on health and social care, every Government has been spending more on the NHS. By 2010 the government hit the target – only to still be behind Germany and France, 6th out of the G7 and below the EU15 average because in the same period most of everyone else were also investing more than before. Based on OECD figures, at the end of 2019 the UK was spending £674 pp less than the EU15 average and would have needed to spend £44.4 bn more to catch up. The extra money promised by the Johnson Government in the 2019 election came to around half this figure.
Pre pandemic the argument was about how much more the taxpayer was willing to pay and how quickly we could aim to catch up whilst politicians masked how in critical areas we were actually falling further behind – for example Richards highlighting that we are not even in the top 30 when it comes to accessing MRI or CT scanners.
However, the pandemic should have changed the context of the investment argument. Having been preaching austerity for a decade Government found whatever monies were needed. Both how and how much they spent on Track and Trace and securing PPE showed all of us that when Government’s want to really prioritise spending more on a national priority they can and they will. Continuing with some of this extra spending and directing it towards the continued catch up by investing more in people and equipment is now clearly an available choice.
Winning the argument for this continued higher investment over the next decade to tackle the recruitment and retention crisis is and will be the first strand of SoR and TUC campaigning.
What to spend it on
Persuading Government to find the extra investment the NHS needs to finally match other leading world economies is the politically difficult step toward securing a New Deal for Radiographers and AHPs. Deciding how and what to spend the extra investment on may be even more difficult. However, now we have won the argument for the principle of recruiting and retaining more radiographers any success we have in identifying what would make the real difference for members, and potential members, could also be the key that unlocks the investment.
We need to have a clear understanding of what would make the critical difference for members. What pay and reward offer would attract more to choose a career in radiography? What support would really make the difference and retain those thinking of leaving? This is why the SoR is starting a national pay and reward conversation with members, seeking to understand what would make the difference for you.
It is unlikely there will be any easy answers. Whilst unions are divided about how much would constitute a fair and sustainable pay award we’d probably all agree that even 12.5% wouldn’t solve the issue on its own…although it would certainly help!
The answers will be more complex than a magic, single number because in a workforce as large and diverse as the NHS the needs and pressures on staff will also be diverse. A single person needing to move to a new City for their first post will have different financial pressures to someone ten years into their career who’s looking for a bigger house for their new family to live in.
Likewise, what attracts people to a career in the first place and their starting point will vary. Someone at 16 choosing their A level subjects with a view to a career in radiography will have a different perspective and priorities about future pay and reward to someone who graduated 15 years earlier looking to retrain for a second career in radiography after being made redundant. Radiography needs all of these people.
We need to start by understanding what is working and what the NHS can’t afford to lose from its pay and reward package then look for what flexibility can be built in and around the package so that it meets the varying and changing needs and priorities of the diverse workforce.
One thing that works well is a clear single national set of pay ranges. Whatever other variation and flexibility is considered it must not undermine this foundation. To introduce local competition would cause chaos, confusion and waste – introducing greater turnover when the problem is needing a more stable workforce. All those considering a career in radiography need to know the basic pay they can expect. This needs to be competitive with alternative careers available with the same qualifications.
Consideration also needs to be given to support and reward before qualification. Scrapping bursaries and including AHP students in the “loan” system had a measurably disastrous and immediate impact on AHP student recruitment and retention. Does a serious strategy have scope to look at greater incentives to choose AHP courses? If so what would these look like? Similarly, other parts of the public sector have now long established earn to train courses for mature students. The NHS is a decade at least behind social work and teaching. Degree apprenticeships are in their pilot phase but the opportunities to expand these seems huge. What would a good “earn to train package” look like and who would qualify? What additional resource would be needed to support this in Trusts?
These are other wider pay and reward questions that reflect the status and standing of radiographers and AHPs. It’s not long ago that any new hospital was built with assisted housing places for new professionals to live in to help them relocate. This was literally an inbuilt NHS cost. Relocation and recruitment packages for hard to find professional posts are a norm for any private sector company recruiting in a global market place. However, at some point this was lost in the NHS. When, in 2015, NHS employers requested permission to borrow to invest in a staff housing programme the Government blocked the request. This seems like the definition of false economy. We need to explore if subsidised housing would make a difference to recruitment and retention. If members say yes we can develop the case for a competitive public sector package.
Pensions is another area where flexibility could be considered but where there is currently little scope. The NHS pension scheme is undoubtably competitive against most private sector schemes. However, it is also complex. Pensions as a concept have had a difficult press and have also been allowed to become more complex since 2010. Evidence shows younger members are less likely to fully engage with the scheme and evidently its real value is more appreciated by those over 50. Is there an opportunity, in creating a New Deal for Radiographers and AHPs to increase engagement and understanding of the scheme by introducing creative flexibilities tailored for different stages of people’s careers? For example, contribution subsidies for those who start off and/or work in geographic areas with acute recruitment and retention challenges? Or what additional role and pension flexibilities may encourage people to work for longer and phase down to retirement rather than leave as soon as they can afford to? Now seems the perfect time to seriously explore these issues and build the case for greater flexibility but we need to know what would make the difference.
Then there is identifying the wider workload pressures that wrap around any pay and reward package. These demonstrate a wider social value and reflect the social status of radiographers and AHP’s. We know instinctively that investment in new equipment, more support staff, genuine access to CPD time and space for professional reflection, access to flexible working on the radiographers terms as opposed to bending to breaking point to meet demand, etc – all make a huge difference to recruitment and retention. The recent Parliamentary report into burnout caused by Covid recognised this and offers a clear approach. However, consultation with SoR members where you share your stories and capture why this makes the difference will greatly help us to win the argument for the investment necessary.
We’re starting this conversation by inviting members in England and Wales to use the text box in the pay award consultation. We will be extending this to members in Scotland and Northern Ireland (where we are continuing to press for a pay settlement) over the coming weeks.
We look forward to members sharing ideas about what will make the difference.
